Skin clip applier

ABSTRACT

A skin clip applier for placing skin clips to close a wound comprises a handle assembly including an actuating element and a cartridge assembly adapted to be affixed to said handle assembly and including skin clip-deforming jaw elements which are actuated by operation of the handle assembly to place and deform preformed skin clips, delivered individually to said deforming jaws, to close a wound.

FIELD OF THE INVENTION

This invention relates to a skin clip applier useful for placing skinclips or staples into the skin across a wound to close the wound and toretain it in a closed and healing position.

BACKGROUND OF THE INVENTION

Whenever it is necessary to close an incision or a wound, whether at thecompletion of a surgical procedure or to repair accidental damage, it isbecoming more and more common for the attending surgeon to choose to usemetal skin clips or staples instead of thread sutures. This has becometrue with the development of stapling devices, or skin clip appliers,particularly suited for surgical use and the consequent speed with whichincision or wound closure can be accomplished by the surgeon with suchdevices as compared to the use of thread suture materials with needlesand the required time-consuming tying of the suture material. See, forexample, U.S. Pat. Nos. 3,643,851 and 3,717,294 which describe skinstaplers and U.S. Pat. No. 4,014,492 which describes a particular typeof staple. When staples or skin clips are used for incision or woundclosure, they are removed with a special removal tool or extractor suchas disclosed in U.S. Pat. No. 4,026,520, or an adaption of the stapleremover, originally designed for removal of staples from paper or likematerial, shown in U.S. Pat. No. 2,202,984.

BRIEF SUMMARY

The skin clip applier of the present invention overcomes disadvantagesof prior skin clip appliers or stapling devices which results in animprovement in the speed and accuracy with which skin clips may beplaced to close an incision or a wound and an improved shape of the skinclip when deformed into place as an incision or a wound closing elementby the present skin clip applier. Such improved shape of the placed skinclip results in considerably less trauma to the patient when the skinclip is removed. The specific advantages of the present skin clipapplier as compared to prior devices will be explained more fully in thefollowing detailed description of an illustrative specific embodiment ofthe invention.

The skin clip applier of this invention is formed of a combination of ahandle assembly and a cartridge assembly which may be adapted to fittogether so that an empty cartridge may be removed and replaced with acartridge full of performed skin clips. The closing action of the handleassembly functions to actuate a pair of jaws in the cartridge assemblyand deform into place as a wound closing element a preformed skin clipwhich is fed between the jaws as the leading one of a plurality of skinclips pre-loaded into the cartridge assembly on a clip carrier and movedtoward and between the pair of jaws by the action of a clip pusher whichis biased toward the jaws. The pair of jaws are pivoted on a singlestud, preferably with elongated pivot holes in each jaw to providelimited movement toward and away from the surface of the skin into whicha skin clip is to be placed. Such movement permits the points of theskin clip to be placed into the skin before actual deformation of theskin clip begins and assists in the approximation and closure of theincision or wound.

BRIEF DESCRIPTION OF THE DRAWINGS

The skin clip applier of this invention will be described in more detailwith reference to the accompanying drawings which show one illustrativespecific embodiment of the invention.

In the drawings:

FIG. 1 is a perspective view of the skin clip applier approximately inthe position of use after having placed skin clips to close an incision.

FIG. 2 shows three steps in the deformation by the skin clip applier ofa single skin clip which is being placed to close an incision or awound.

FIG. 3 is a side view of the handle of the skin clip applier partly insection.

FIG. 4 is a section of the cartridge taken along line 4--4 of FIG. 3.

FIG. 5 is an enlarged partial view of the applier showing the skin clipin position between the jaws of the skin clip applier just prior toactual deformation.

FIG. 6 is a side view partly in section of the cartridge assembly.

FIG. 7 is a view partly in section of the cartridge taken along line7--7 of FIG. 6.

FIG. 8 is a section of the cartridge taken along line 8--8 of FIG. 6.

FIG. 9 is a perspective and exploded view showing the relation of partsof the cartridge assembly to the actuating element of the handleassembly.

DETAILED DESCRIPTION

With reference to the accompanying drawings, the same parts areidentified by the same reference numerals in all figures.

In FIG. 1, a specific embodiment of the skin clip applier of the presentinvention, indicated generally by reference numeral 20, is shown in anattitude of use after having placed five skin clips 10 to close a woundor an incision 11. The skin clip applier 20 includes a handle assembly30 and a cartridge assembly 40 which are detachable one from the other.

It is to be understood, however, that the skin clip applier of thisinvention may have a handle assembly and cartridge assembly incorporatedinto a unitary device rather than as detachable elements.

FIG. 2 (three views) shows a skin clip 10 in progressive stages ofdeformation during the placing of the skin clip 10. In the first view,the points 12 of the skin clip 10 have just punctured the skin as thebottom edge of the cartridge assembly 40 of the skin clip applier 20 isbrought into contact with the incision or wound 11. At this stage thedeformation of the skin clip 10 has not actually begun, but the skinclip 10 is held in a position, as will be explained in more detailhereinafter, such that the points 12 extend below the bottom edge of thecartridge assembly 40 to permit contact with and penetration of the skinto maintain the approximation of the wound or incision site. In thesecond view, the skin clip 10 has been partially deformed and the points12 of the skin clip 10 have substantially completed their penetration tohold the wound or incision 11 in a closed position. In the third view,the skin clip 10 is fully deformed and placed to hold the wound orincision together. It should be noted here that the fully deformed skinclip 10 is holding the wound or incision 11 closed in a buttedrelationship. If desired, the wound may be approximated in a slightlyeverted attitude and the skin clips 10 applied. In either procedure, thetop of the skin clip 10 is not touching but is slightly separated fromthe wound or incision 11, and the top of the skin clip 10 is boweddownwardly to a slight extent, i.e., it has not been deformed to a pointthat the top of the skin clip 10 is absolutely straight. Both of theseconditions are important from the standpoint of patient comfort both incase of any swelling of the wound or incision site 11 and the subsequentremoval of the skin clips 10, and both conditions are brought about bythe action of the skin clip applier 20.

The handle assembly 30, as shown in FIG. 3, includes a frame 31, ahandle 32, a compression spring 33, a pivot axle 34, and a cam 35. Theframe 31 and handle 32 are connected through the pivot axle 34 so thatthe gripping end of the handle 32 is permitted to move about the pivotaxle 34 into contact with (dotted outline) and away from (solid outline)the frame 31. On the opposite end of the handle 32, i.e., on the otherside of pivot axle 34 and at the extreme end, the cam 35 is attached andis the actuating element of the handle assembly 30 which cooperates withthose elements of the cartridge assembly 40 which actually deform a skinclip 10 during placement of the skin clip 10. The compression spring 33is present to bias the handle 32 in the open position, i.e., with thegripping portion at its most remote position from the frame 31. The openend or pivot axle 34 end of the frame 31 is shaped to receive thecartridge assembly 40 therein in such a manner that the cam 35 ispositioned within the cartridge assembly 40 in order to be in engagementwith certain elements therein as will be explained in detailhereinafter.

The cartridge assembly 40 is shown in detail in FIGS. 4 through 9 whichillustrate the various elements of the cartridge assembly 40 and howsuch elements function to present and deform a skin clip 10 whenactuated by the downward movement of cam 35 as the result of closing thehandle 32 into virtual contact with the frame 31 when the surgeon closeshis hand while gripping the frame 31 and handle 32 of the handleassembly 30 of the skin clip applier 20.

The cartridge assembly 40 includes jaws 41 and 42 pivoting on stud 43which is fastened into front plate 45. The hub 44 shown on the frontplate 45 is not a required element but is present simply to provide amore substantial bulk of material into which the stud 43 can befastened. Jaws 41 and 42 are formed with elongated holes 41a and 42awhich fit over stud 43 and provide for limited vertical motion of thejaws 41 and 42 as will become apparent from the subsequent description.Torsion spring 46 is mounted on and around stud 43 after the jaws 41 and42 are placed thereon. One free end of torsion spring 46 is attached tojaw 41 at 41e and the other free end is attached to jaw 42 at 42e in amanner such that the jaws 41 and 42 are biased both in the uppermostposition permitted by the elongated holes 41a and 42a and in an openposition, i.e., the deforming surfaces 41b and 42b are at their mostseparated position and the cam bearing surfaces 41c and 42c are at theirclosest position. The deforming surfaces 41b and 42b must move in thesame plane, and the cam bearing surfaces 41c and 42c most convenientlymove in the same plane. Consequently, one of the jaws is offsetsufficiently to move the deforming surface and the cam bearing surfaceinto line with those of the other jaw. With the cartridge assembly 40connected to the handle assembly 30, when cam 35 is moved from itsextreme biased position to its opposite limited position by the closingof the handle 32 to or into the frame 31, the specifically shapedundersurface of cam 35 contacts the cam bearing surfaces 41c and 42c ofjaws 41 and 42 and smoothly moves these surfaces 41c and 42c down andapart, as best illustrated in FIG. 4. As a consequence of this movementof cam bearing surfaces 41c and 42c, the whole bodies of the jaws 41 and42 are moved down to the limit provided by the elongated holes 41a and42a and the deforming surfaces 41b and 42b move into skin clip deformingrelation. Stops 47 and 48 are provided in the form of bosses on theinside surface of front plate 45 to limit the movement of jaws 41 and 42to prevent excess deformation of skin clip 10.

As the deforming surfaces 41b and 42b are moved toward each other by theaction of cam 35 when the handle is being closed, the skin clip 10positioned therebetween (as best illustrated in FIG. 5) will be deformedthrough the stages illustrated in FIG. 2. During such deformation ofskin clip 10, it is held in proper position with the aid of grooves orcoining slots 41d and 42d in the deforming surfaces 41b and 42b and theupward movement of skin clip 10 as it is deformed is limited by the stop49 which is shown as a boss on the inside surface of front plate 45 butmay be provided elsewhere, as for example, on the forward end of carriercover 52. The surface 49a of stop 49 is curved to fit the arcuate shapeof the top of skin clip 10 and this assists in maintaining a slightdownward bow in the top of the skin clip 10 when it is fully deformed asshown in the third and last view of FIG. 2. As explained previously,this slight downward bow in the top of the fully deformed skin clip 10is an important feature from the standpoint of patient comfort,particularly during the removal of skin clip 10.

The skin clip delivery system forming a part of the cartridge assembly40 includes a skin clip carrier (or slide) 50, a skin clip pusher 51, askin clip carrier cover 52, and a biasing spring 53 to bias the skinclip pusher 51 and thereby the skin clips 10 on carrier 50 toward thefront plate 45 and the deforming jaws 41 and 42. Skin clip carrier 50forms the bottom of the cartridge assembly 40 and carrier cover 52 fitsover carrier 50 to provide a passageway for the skin clips 10 and skinclip pusher 51 and prevent any binding of skin clip pusher 51 on carrier50. Carrier cover 52 includes a slot 52c to permit passage of the skinclip pusher boss 51a. The forward ends 50a and 52a of the carrier 50 andcarrier cover 52 abut and are fastened to front plate 45 to form themajor portion of the cartridge assembly 40. Skin clips 10 are loadedonto carrier 50 and skin clip pusher 51 is then placed on the carrier50. Biasing spring 53, preferably a constant force spring such as asaddle spring, is then affixed to the forward end 52a of carrier cover52 and to skin clip pusher 51. As shown in FIG. 9, the free ends in coilform of spring 53 are placed in the spring wells 52b of carrier cover 52and the loop or middle of the spring 53 is placed around the boss 51a ofthe skin clip pusher 51 to bias the skin clips 10 toward the deformingjaws 41 and 42. A specially shaped boss 54 on the inside wall of frontplate 45 provides a partial cover for the spring wells 52b and therebyretains the ends of spring 53 therein.

In FIG. 9, a clip 10 is shown resting on the carrier 50 which is shapedto conform to the preformed clip 10. When contacted by the angled (about30° as shown) forward face or contact surface of the pusher 51, the clip10 will assume an angled position on carrier 50 (as most clearly shownin FIG. 6) such that the clip 10 is at all times parallel to the insidesurface of the front plate 45 and the plane of deforming movement of thejaws 41 and 42. The forward end of skin clip carrier 50 is provided witha lift 50b which serves to prevent the clips 10 from sliding off theforward end of carrier 50 and also locates or positions each clip 10 sothat it is properly presented to the deforming jaws 41 and 42.

The bottom of front plate 45 and the bottom of skin clip carrier 50 arecut out to provide a channel 55 slightly wider than a deformed skin clip10 to permit the skin clip applier 20 to pass over the everted wound andany skin clips implanted in the wound.

As shown in FIGS. 1 and 6, the front plate 45 may be provided with apositioning guide 44a to assist in the accurate placing of the skinclips 10.

The skin clip applier of the present invention is simple and sturdy inconstruction and functions to place skin clips in a wound or incisionclosing site in a manner that results in a minimum of patient discomfortbecause it provides room for any swelling of the site and results in ashape of placed skin clip which can be removed with the least trauma.This latter result is accomplished because of the slight downward bow ofthe top of the skin clip (as shown in the third view of FIG. 2) whichminimizes rotation or warping of the skin clip by the customary removaltool or extractor, and consequently, during removal it minimizes anydistortion or scraping by the withdrawing pointed legs of the skin clipof the entry holes formed by the pointed legs during placement of theskin clip. The downward bow of the skin clip placed by the skin clipapplier of the present invention requires less force to deform duringremoval than the upward bow of those skin clips placed by other skinclip appliers. Skin clip appliers or staplers which utilize an anvilabout which a skin clip or staple is formed must of necessity have anupward bow to the top of such a skin clip because the anvil limits thedeformation to a theoretical flat or straight top of such a skin clip,but in practice an upward bow will be present. Such upward bow has beenfound to occassionally cause warping and rotation during removal by thecustomary removal tools.

The skin clips used by the skin clip applier of the present inventionare customarily of stainless steel, and 316L stainless steel ispreferred. The skin clips are conventionally formed of stainless steelwire which may be of varying thickness, and the skin clips may be ofvarious sizes. Because the skin clips used by the present applier arepreformed into the particular shape described hereinbefore, a lesserforce is required to deform the clip into its final woundclosing shape.This makes it possible to provide an applier the use of which is lesstiring to the surgeon.

What is claimed is:
 1. A skin clip applier comprising in combination ahandle assembly and a skin clip cartridge assembly, said handle assemblycomprising a handle pivotally connected within its length to a frame,means to bias one end of said handle away from said frame, a cam elementattached to the opposite end of the handle and means for affixing theskin clip cartridge assembly in operative relation to said cam elementof said handle assembly, said cartridge assembly comprising a skin clipdelivery system adapted to present individual pre-formed skin clipsserially to a pair of jaw elements pivotally mounted for deforming saidskin clips, means to bias said deforming jaw elements away from eachother, and means for affixing the handle assembly in operative relationto the jaw elements of said cartridge assembly to force said jawelements into deforming relation to each of the skin clips, the handleand the cam element each having a longitudinal axis substantiallyperpendicular to the plane of said jaw elements.
 2. A skin clip applieraccording to claim 1 wherein each of said pair of jaw elements has apivot hole elongated to provide limited movement of said jaw elements toand away from a position of deformation of said skin clip by said jawelements.
 3. A handle assembly for a skin clip applier comprising ahandle pivotally connected within its length to a frame, means to biasone end of said handle away from said frame, a cam element attached tothe opposite end of the handle and means for affixing a skin clipcartridge assembly, including a pair of skin clip deforming jawelements, in operative relation to said cam element of said handleassembly, the handle and the cam element each having a longitudinal axissubstantially perpendicular to the plane of said jaw elements.
 4. Acartridge assembly for a skin clip applier comprising a skin clipdelivery system adapted to present individual pre-formed skin clipsserially to a pair of jaw elements pivotally mounted for deforming saidskin clips, means to bias said deforming jaw elements away from eachother, and means for affixing an actuating handle assembly, including ahandle and a cam element attached to said handle at a handle endadjacent to said jaw elements, in operative relation to the jaw elementsof said cartridge assembly to force said jaw elements into deformingrelation to each of the skin clips, the handle and the cam element eachhaving a longitudinal axis substantially perpendicular to the plane ofsaid jaw elements.
 5. A cartridge assembly according to claim 4 whereineach of said pair of jaw elements has a pivot hole elongated to providelimited movement of said jaw elements to and away from a position ofdeformation of said skin clip by said jaw elements, and means to movesaid jaw elements to said position of deformation.
 6. A skin clipapplier comprising in combination a handle assembly and a skin clipcartridge assembly, said handle assembly comprising a handle pivotallyconnected within its length to a frame, means to bias one end of saidhandle away from said frame, and a cam element attached to the oppositeend of the handle, said cartridge assembly being joined to said handleassembly in operative relation to said cam element of said handleassembly, said cartridge assembly comprising a skin clip delivery systemadapted to present individual pre-formed skin clips serially to a pairof jaw elements pivotally mounted for deforming said skin clips, meansto bias said deforming jaw elements away from each other, and means foraffixing the handle assembly in operative relation to the jaw elementsof said cartridge assembly to force said jaw elements into deformingrelation to each of the skin clips, the handle and the cam element eachhaving a longitudinal axis substantially perpendicular to the plane ofsaid jaw elements.
 7. A skin clip applier according to claim 6 whereineach of said pair of jaw elements has a pivot hole elongated to providelimited movement of said jaw elements to and away from a position ofdeformation of said skin clip by said jaw elements.